Impact of Alcohol Abstinence on the Risk of Hepatocellular Carcinoma in Patients With Alcohol-Related Liver Cirrhosis - PubMed (original) (raw)

Manuel Rodríguez et al. Am J Gastroenterol. 2021.

Abstract

Introduction: Although alcohol cessation is the only effective treatment for alcohol-related liver disease, few data exist concerning its influence on the risk of hepatocellular carcinoma (HCC). We aimed to evaluate the effect of alcohol abstinence on the incidence of HCC in patients with alcohol-related cirrhosis.

Methods: We studied 727 patients with alcohol-related cirrhosis (247 with compensated disease and 480 with previous decompensation) who were included in a surveillance program for the early detection of HCC and prospectively followed. Baseline clinical and biological parameters and alcohol consumption during follow-up were recorded. Abstinence was defined as the absence of any alcohol use.

Results: During follow-up (median 54 months), 354 patients (48.7%) remained abstinent and 104 developed HCC (2.3 per 100 person-years). Factors independently associated with the risk of HCC among patients with previous decompensation were age, male gender, and aspartate aminotransferase, whereas abstinence was not linked to a reduced risk (hazard ratio 0.95; 95% confidence interval 0.59-1.52). However, among patients without previous decompensation, prothrombin activity and abstinence were independently associated with the risk of HCC. Abstinent patients had a significant decrease in the risk of developing tumor (hazard ratio 0.35; 95% confidence interval 0.13-0.94). These results did not change after applying a competing risk analysis where death and liver transplantation were considered as competing events.

Discussion: Alcohol abstinence reduced the risk of HCC in patients with alcohol-related cirrhosis, but only in those without a history of decompensated disease. This finding emphasizes the need for an early diagnosis of alcohol-related liver disease and for implementing strategies leading to an increase in the rate of achieving and maintaining abstinence among this population.

Copyright © 2021 by The American College of Gastroenterology.

PubMed Disclaimer

Similar articles

Cited by

References

    1. GBD 2017 Cirrhosis Collaborators. The global, regional, and national burden of cirrhosis by cause in 195 countries and territories, 1990–2017: A systematic analysis for the Global Burden of Disease Study 2017. Lancet Gastroenterol Hepatol 2020;5:245–66.
    1. Pimpin L, Cortez-Pinto H, Negro F, et al. Burden of liver disease in Europe: Epidemiology and analysis of risk factors to identify prevention policies. J Hepatol 2018;69:718–35.
    1. Moon AM, Yang JY, Barritt AS IV, et al. Rising mortality from alcohol-associated liver disease in the United States in the 21st century. Am J Gastroenterol 2020;115:79–87.
    1. LoConte NK, Brewster AM, Kaur JS, et al. Alcohol and cancer: A statement of the American Society of Clinical Oncology. J Clin Oncol 2018;36:83–93.
    1. Paik JM, Golabi P, Younossi Y, et al. Changes in the global burden of chronic liver diseases from 2012 to 2017: The growing impact of nonalcoholic fatty liver disease. Hepatology 2020;72:1605–16.

MeSH terms

LinkOut - more resources